Far Too Few With Treatment-Resistant Hypertension Get Hormon
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Primary aldosteronism is a common cause of treatment-resistant hypertension. However, evidence from local health systems suggests low rates of testing for primary aldosteronism.

This retrospective cohort study in the setting of US health veterans aimed to evaluate testing rates for primary aldosteronism and evidence-based hypertension management in patients with treatment-resistant hypertension.

The participants were 269010 veterans with apparent treatment-resistant hypertension from 2000 to 2017, defined as either 2 blood pressures (BPs) of at least 140 mm Hg (systolic) or 90 mm Hg (diastolic) at least 1 month apart during use of 3 antihypertensive agents (including a diuretic), or hypertension requiring 4 antihypertensive classes.

Rates of primary aldosteronism testing (plasma aldosterone–renin) and the association of testing with evidence-based treatment using a mineralocorticoid receptor antagonist (MRA) and with longitudinal systolic BP were measured.

Results:
-- 4277 (1.6%) patients who were tested for primary aldosteronism were identified.

-- An index visit with a nephrologist or an endocrinologist was associated with a higher likelihood of testing compared with primary care.

-- Testing was associated with a 4-fold higher likelihood of initiating MRA therapy and with better BP control over time.

Conclusively, in a nationally distributed cohort of veterans with apparent treatment-resistant hypertension, testing for primary aldosteronism was rare and was associated with higher rates of evidence-based treatment with MRAs and better longitudinal BP control. The findings reinforce prior observations of low adherence to guideline-recommended practices in smaller health systems and underscore the urgent need for improved management of patients with treatment-resistant hypertension.

Source: https://www.acpjournals.org/doi/10.7326/M20-4873
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